Tremor differential diagnosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(3 intermediate revisions by 2 users not shown)
Line 7: Line 7:


==Differentiating Tremor from other Diseases==
==Differentiating Tremor from other Diseases==
*Tremor must be differentiated from diseases that cause involuntary movement<ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298  }} </ref>:
*Tremor must be differentiated from diseases that cause involuntary movement: <ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298  }} </ref>
**[[Myoclonus]]: Brief [[muscle]] twitches, limited to single [[limb]] or to adjacent parts.[[EEG]] shows association with spike-wave complexes.
**[[Myoclonus]]: Brief [[muscle]] twitches, limited to single [[limb]] or to adjacent parts.[[EEG]] shows association with spike-wave complexes.
**[[Clonus]]: Rhythmic movement aggravated by [[muscle]] stretching.
**[[Clonus]]: Rhythmic movement aggravated by [[muscle]] stretching.
Line 15: Line 15:


{| class="wikitable"
{| class="wikitable"
| '''Common Cause of Tremor''' ||  '''Differentiating Feature of Tremor''' || '''Main Feature of Disease'''
!align="center" style="background: #4479BA; color: #FFFFFF | '''Common Cause of Tremor'''
! align="center" style="background: #4479BA; color: #FFFFFF|  '''Differentiating Feature of Tremor'''  
! align="center" style="background: #4479BA; color: #FFFFFF| '''Main Feature of Disease'''
  |-
  |-
  | [[Essential tremor]] || Postural Tremor - [[Frequency]] 4–12 Hz, Bilateral onset || [[gait]] [[ataxia]], [[vestibulo-cerebellar]] involvement, reduced by [[alcohol]], [[family history]], [[stress]]/[[fatigue]] can increase tremor [[amplitude]], increases with voluntary movements
  | [[Essential tremor]] || Postural Tremor - [[Frequency]] 4–12 Hz, Bilateral onset || [[gait]] [[ataxia]], [[vestibulo-cerebellar]] involvement, reduced by [[alcohol]], [[family history]], [[stress]]/[[fatigue]] can increase tremor [[amplitude]], increases with voluntary movements
Line 31: Line 33:
  | [[Orthostatic]] Tremor || [[Essential tremor]] variant, high [[frequency]] 14 Hz-18 Hz|| Occurs in the [[legs]] on standing and is relieved by sitting down
  | [[Orthostatic]] Tremor || [[Essential tremor]] variant, high [[frequency]] 14 Hz-18 Hz|| Occurs in the [[legs]] on standing and is relieved by sitting down
  |-
  |-
  |Holmes tremor ||  Combination of rest, action, and postural tremors, [[Frequency]] 2Hz-5Hz ||  
  |Holmes tremor ||  Combination of rest, action, and postural tremors, [[Frequency]] 2Hz-5Hz || Mostly due to [[vascular]] [[lesion]] in [[mesencephalic]], [[thalamic]] or both regions.
|}
|}


Line 37: Line 39:
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
[[Category:Neurology]]
{{WS}}
[[Category:Primary care]]
[[Category: (name of the system)]]
[[Category:Signs and symptoms]]
[[Category:Medicine]]

Latest revision as of 20:38, 18 February 2021

Tremor Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tremor from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Tremor differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tremor differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Tremor differential diagnosis

CDC on Tremor differential diagnosis

Tremor differential diagnosis in the news

Blogs on Tremor differential diagnosis

Directions to Hospitals Treating Tremor

Risk calculators and risk factors for Tremor differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Tremor must be differentiated from diseases that cause involuntary movement: myoclonus, clonus, asterixis, and epilepsia partialis continua. The cause of tremor must also be differentiated from other conditions that cause tremor: essential tremor, physiological tremor, Parkinson's disease, cerebellar tremor, orthostatic tremor.

Differentiating Tremor from other Diseases

Common Cause of Tremor Differentiating Feature of Tremor Main Feature of Disease
Essential tremor Postural Tremor - Frequency 4–12 Hz, Bilateral onset gait ataxia, vestibulo-cerebellar involvement, reduced by alcohol, family history, stress/fatigue can increase tremor amplitude, increases with voluntary movements
Parkinson’s disease Resting Tremor - Unilateral onset Bradykinesia, micrographia, stooped posture, ataxia, rigidity, imbalance, depression, apathy, decreases with voluntary movements
Physiologic Tremor Postural tremor - High frequency 8–10 Hz, low amplitude, irregular oscillations Tremor occurs while maintaining a posture and mostly disappears if eyes are closed or a load is placed on the muscles. Subtle innate tremor normally present in the general population.
Enhanced Physiologic Tremor Increased amplitude Physiologic tremor enhanced due to fatigue, sleep deprivation, drugs, endocrine disorders, caffeine, stress.
Cerebellar Tremor Intention tremor - Low frequency <4 Hz Occurs in multiple sclerosis, stroke, brainstem tumor, or cerebellar trauma. May feature ataxia, dysmetria, dysdiadochokinesia, and dysarthria.
Drug Induced Tremor Can enhance rest, action, postural tremors Amiodarone, bronchodilators, lithium, metoclopramide, neuroleptics, theophylline, valproate
Orthostatic Tremor Essential tremor variant, high frequency 14 Hz-18 Hz Occurs in the legs on standing and is relieved by sitting down
Holmes tremor Combination of rest, action, and postural tremors, Frequency 2Hz-5Hz Mostly due to vascular lesion in mesencephalic, thalamic or both regions.

References

  1. Bhidayasiri R (2005). "Differential diagnosis of common tremor syndromes". Postgrad Med J. 81 (962): 756–62. doi:10.1136/pgmj.2005.032979. PMC 1743400. PMID 16344298.
  2. Deuschl G, Elble R (2009). "Essential tremor--neurodegenerative or nondegenerative disease towards a working definition of ET". Mov Disord. 24 (14): 2033–41. doi:10.1002/mds.22755. PMID 19750493.
  3. Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
  4. Crawford P, Zimmerman EE (2011). "Differentiation and diagnosis of tremor". Am Fam Physician. 83 (6): 697–702. PMID 21404980.